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Hansen KN, Maehara A, Noori M, Trøan J, Fallesen CO, Hougaard M, Ellert-Gregersen J, Veien KT, Junker A, Hansen HS, Lassen JF, Jensen LO. Optimal lesion preparation before implantation of a Magmaris bioresorbable scaffold in patients with coronary artery stenosis: Rationale, design and methodology of the OPTIMIS study. Contemp Clin Trials Commun 2024; 38:101260. [PMID: 38384894 PMCID: PMC10879808 DOI: 10.1016/j.conctc.2024.101260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/02/2024] [Accepted: 01/15/2024] [Indexed: 02/23/2024] Open
Abstract
Introduction Percutaneous coronary intervention with implantation of a bioresorbable scaffold (BRS) provide the vessel support for a limited period allowing the vessel to restore normal vasomotion after degradation of the BRS, opposed to treatment with drug-eluting stents where the metal persist in the vessel wall. Late lumen loss and reduction in lumen area after implantation have been reported. The purpose of this study was to investigate whether intense pre-dilatation before BRS implantation resulted in less reduction of minimal lumen area at 6- and 12-month follow-up after implantation of a Magmaris BRS (MgBRS). Coronary imaging with optical coherence tomography (OCT) and intravascular ultrasound (IVUS) was assessed to track changes in lumen and vessel dimensions. Methods The prospective Optimal lesion PreparaTion before Implantation of the Magmaris bioresorbable scaffold In patients with coronary artery Stenosis (OPTIMIS) study randomly assigned eighty-two patients with chronic coronary syndrome to two pre-dilatation treatment strategies. Patients were randomized in a 1:1 ratio to pre-dilatation with either a non-compliant scoring balloon or a standard non-compliant balloon prior to implantation of a MgBRS. The treated segment was evaluated with OCT and IVUS at baseline, after 6 and 12 months to assess changes in lumen and vessel dimensions. The hypothesis was that more intense pre-dilatation with a non-compliant scoring balloon before MgBRS implantation can reduce the risk of late lumen reduction compared to standard pre-dilatation. The power calculation used expected MLA after 6 months (6.22 mm2 for the scoring balloon and 5.01 mm2 for the standard non-compliant balloon), power of 80 %, significance level of 0.05 and expected drop-out rate of 15 %, requiring 82 patients to be enrolled. Results Eighty-two patients were included in the study. Enrollment was from December 2020 to September 2023. Conclusion The hypothesis was that more intense pre-dilatation with a non-compliant scoring balloon before MgBRS implantation can reduce the risk of late lumen reduction compared to standard pre-dilatation.
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Affiliation(s)
- Kirstine Nørregaard Hansen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
| | - Akiko Maehara
- Cardiovascular Research Foundation, New York Presbyterian Hospital, New York, USA
| | - Manijeh Noori
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
| | - Jens Trøan
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Mikkel Hougaard
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | | | - Anders Junker
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Henrik Steen Hansen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
| | - Jens Flensted Lassen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
| | - Lisette Okkels Jensen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
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Khatami M, Doniavi A, Abazari AM, Fotouhi M. Enhancing flexibility and strength-to-weight ratio of polymeric stents: A new variable-thickness design approach. J Mech Behav Biomed Mater 2024; 150:106262. [PMID: 38029464 DOI: 10.1016/j.jmbbm.2023.106262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 12/01/2023]
Abstract
This paper presents a new design strategy to improve the flexibility and strength-to-weight ratio of polymeric stents. The proposed design introduces a variable-thickness (VT) stent that outperforms conventional polymeric stents with constant thickness (CT). While polymeric stents offer benefits like flexibility and bioabsorption, their mechanical strength is lower compared to metal stents. To address this limitation, thicker polymer stents are used, compromising flexibility and clinical performance. Leveraging advancements in 3D printing, a new design approach is introduced in this study and is manufactured by the Liquid Crystal Display (LCD) 3D printing method and PLA resin. The mechanical performance of CT and VT stents is compared using the Finite Element Method (FEM), validated by experimental tests. Results demonstrate that the VT stent offers significant improvements compared to a CT stent in bending stiffness (over 20%), reduced plastic strain distribution of expansion (over 26%), and increased radial strength (over 10%). This research showcases the potential of the VT stent design to enhance clinical outcomes and patient care.
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Affiliation(s)
- Mohamad Khatami
- Department of Mechanical Engineering, Faculty of Engineering, Urmia University, Urmia, Iran.
| | - Ali Doniavi
- Department of Mechanical Engineering, Faculty of Engineering, Urmia University, Urmia, Iran.
| | - Amir Musa Abazari
- Department of Mechanical Engineering, Faculty of Engineering, Urmia University, Urmia, Iran.
| | - Mohammad Fotouhi
- Department of Materials, Mechanics, Management & Design (3MD), Faculty of Civil Engineering and Geosciences, Delft University of Technology, Delft, the Netherlands.
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Shi D, Kang Y, Jiang Z, Li X, Zhang H, Wang Q, Guo J, Jiang H, Luo Q, Ding J. Hybrid interpenetrating network of polyester coronary stent with tunable biodegradation and mechanical properties. Biomaterials 2024; 304:122411. [PMID: 38061184 DOI: 10.1016/j.biomaterials.2023.122411] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 11/20/2023] [Accepted: 11/26/2023] [Indexed: 12/30/2023]
Abstract
Poly(l-lactide) (PLLA) is an important candidate raw material of the next-generation biodegradable stent for percutaneous coronary intervention, yet how to make a polyester stent with sufficient mechanical strength and relatively fast biodegradation gets to be a dilemma. Herein, we put forward a hybrid interpenetrating network (H-IPN) strategy to resolve this dilemma. As such, we synthesize a multi-functional biodegradable macromer of star-like poly(d,l-lactide-co-ɛ-caprolactone) with six acrylate end groups, and photoinitiate it, after mixing with linear PLLA homopolymer, to trigger the free radical polymerization. The resultant crosslinked polymer blend is different from the classic semi-interpenetrating network, and partial chemical crosslinking occurs between the linear polymer and the macromer network. Combined with the tube blow molding and the postprocessing laser cutting, we fabricate a semi-crosslinked-polyester biodegradable coronary stent composed of H-IPN, which includes a physical network of polyester spherulites and a chemical crosslinking network of copolyester macromers and a part of homopolymers. Compared with the currently main-stream PLLA stent in research, this H-IPN stent realizes a higher and more appropriate biodegradation rate while maintaining sufficient radial strength. A series of polymer chemistry, polymer physics, polymer processing, and in vitro and in vivo biological assessments of medical devices have been made to examine the H-IPN material. The interventional implanting of the H-IPN stent into aorta abdominalis of rabbits and the follow-ups to 12 months have confirmed the safety and effectiveness.
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Affiliation(s)
- Daokun Shi
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Fudan University, Shanghai, 200438, China
| | - Yahong Kang
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Fudan University, Shanghai, 200438, China; Shanghai Key Laboratory of Interventional Medical Devices and Equipment, Shanghai MicroPort Medical Group Co., Ltd, Shanghai, 201203, China
| | - Zailai Jiang
- Shanghai Key Laboratory of Interventional Medical Devices and Equipment, Shanghai MicroPort Medical Group Co., Ltd, Shanghai, 201203, China
| | - Xin Li
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Fudan University, Shanghai, 200438, China
| | - Hongjie Zhang
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Fudan University, Shanghai, 200438, China
| | - Qunsong Wang
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Fudan University, Shanghai, 200438, China
| | - Jingzhen Guo
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Fudan University, Shanghai, 200438, China
| | - Hongyan Jiang
- Shanghai Key Laboratory of Interventional Medical Devices and Equipment, Shanghai MicroPort Medical Group Co., Ltd, Shanghai, 201203, China.
| | - Qiyi Luo
- Shanghai Key Laboratory of Interventional Medical Devices and Equipment, Shanghai MicroPort Medical Group Co., Ltd, Shanghai, 201203, China
| | - Jiandong Ding
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Fudan University, Shanghai, 200438, China.
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Bioresorbable Vascular Scaffolds: a Dissolving Dream? Cardiovasc Drugs Ther 2023; 37:1-3. [PMID: 36374359 DOI: 10.1007/s10557-022-07401-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 11/16/2022]
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Bjorkman K, Maldonado JR, Saey S, McLennan D. In vitro performance of Lifetech IBS Angel™ (iron-based bioresorbable scaffold) stents during overdilation for use in pediatric patients. Front Cardiovasc Med 2022; 9:1006063. [DOI: 10.3389/fcvm.2022.1006063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/13/2022] [Indexed: 11/11/2022] Open
Abstract
ObjectivesThe objective of this study was to assess the mechanical performance of the Lifetech IBS Angel stents during overdilation as is often required in pediatric applications; including time of first fracture, foreshortening, and the type of fracturing that occurs.Materials and methodsIn vitro testing was performed and repeated for each stent three times under physiologic conditions with continuous audiovisual imaging allowing for post-testing evaluations. Assessment of sheath fit was also completed.ResultsA total of 47 stents on monorail system were overdilated to complete fracture after passing through either a 4 or 5 French sheath. First strut fracture occurred in 4 and 6 mm stents when they reached greater than 50% overexpansion. Larger stents could achieve at least 30% increased diameter prior to first strut fracture. No fragmentation of any of the stents was seen throughout testing.ConclusionThe IBS Angel has thin struts allowing for a lower profile with increased maneuverability and use with smaller sheaths. Embolization potential of strut fragments was not seen. Increased diameter well beyond design parameters was seen in all with acceptable foreshortening.
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Li Y, Wang Y, Shen Z, Miao F, Wang J, Sun Y, Zhu S, Zheng Y, Guan S. A biodegradable magnesium alloy vascular stent structure: Design, optimisation and evaluation. Acta Biomater 2022; 142:402-412. [PMID: 35085798 DOI: 10.1016/j.actbio.2022.01.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/05/2022] [Accepted: 01/18/2022] [Indexed: 02/07/2023]
Abstract
The existing biodegradable magnesium alloy stent (BMgS) structure is prone to problems, such as insufficient support capacity and early fracture at areas of concentrated stress. Herein, a stent structural design, which reduced the cross section of the traditional sin-wave stent by nearly 30% and introduces a regular arc structure in the middle of the support ring. The influence of the dual-parameter design of bending radius (r) and ring length (L) on plastic deformation, expansion and compression resistance performances are discussed. The non-dominated sorting genetic algorithm II (NSGA-II) was used to search for the optimal solution. It was found that the introduction of parameter r effectively improved the plastic deformation and expansion performance, and the reduction of L improved stent compression resistance. Finally, an optimized stent configuration was obtained. In vitro mechanical tests, including balloon inflation, radial strength and flexibility, verified the simulation results. The radial strength for the optimised stent increases by approximately 40% compared with that for the sinusoidal stent. Microarea X-ray diffraction result shows that the circumferential residual stress for the optimised stent decreases by half compared with that for the sinusoidal stent, thus effectively reducing the stress concentration phenomenon. STATEMENT OF SIGNIFICANCE: Despite current progress in BMgS research, the optimal design of the structure is limited. We present a new type of structurally designed stent. The performance of this stent was analysed by a finite element method and experimentally verified. The structural design positively influenced stent performance.
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Affiliation(s)
- Yafei Li
- School of Materials Science and Engineering, Zhengzhou University, Zhengzhou 450001, China
| | - Yan Wang
- School of Materials Science and Engineering, Zhengzhou University, Zhengzhou 450001, China
| | - Zhenquan Shen
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Fulong Miao
- School of Materials Science and Engineering, Zhengzhou University, Zhengzhou 450001, China
| | - Jianfeng Wang
- School of Materials Science and Engineering, Zhengzhou University, Zhengzhou 450001, China; Henan Key Laboratory of Advanced Magnesium Alloys, Zhengzhou 450002, China; Key Laboratory of Advanced Materials Processing & Mold Ministry of Education, Zhengzhou 450002, China
| | - Yufeng Sun
- School of Materials Science and Engineering, Zhengzhou University, Zhengzhou 450001, China; Henan Key Laboratory of Advanced Magnesium Alloys, Zhengzhou 450002, China; Key Laboratory of Advanced Materials Processing & Mold Ministry of Education, Zhengzhou 450002, China
| | - Shijie Zhu
- School of Materials Science and Engineering, Zhengzhou University, Zhengzhou 450001, China; Henan Key Laboratory of Advanced Magnesium Alloys, Zhengzhou 450002, China; Key Laboratory of Advanced Materials Processing & Mold Ministry of Education, Zhengzhou 450002, China
| | - Yufeng Zheng
- School of Materials Science and Engineering, College of Engineering, Peking University, Beijing 100871, China
| | - Shaokang Guan
- School of Materials Science and Engineering, Zhengzhou University, Zhengzhou 450001, China; Henan Key Laboratory of Advanced Magnesium Alloys, Zhengzhou 450002, China; Key Laboratory of Advanced Materials Processing & Mold Ministry of Education, Zhengzhou 450002, China.
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7
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Barkholt TØ, Neghabat O, Holck EN, Andreasen LN, Christiansen EH, Holm NR. Bioresorbable magnesium scaffold in the treatment of simple coronary bifurcation lesions: The BIFSORB pilot II study. Catheter Cardiovasc Interv 2021; 99:1075-1083. [PMID: 34967094 PMCID: PMC9540410 DOI: 10.1002/ccd.30051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/18/2021] [Accepted: 12/12/2021] [Indexed: 11/09/2022]
Abstract
Objectives To evaluate the feasibility, safety, and healing response of a magnesium‐based bioresorbable scaffold (BRS) in the treatment of simple bifurcation lesions using the single stent provisional technique. Background BRS may hold potential advantages in the treatment of coronary bifurcation lesions, however low radial strength and expansion capacity has been an issue with polymer‐based scaffolds. The magnesium BRS may prove suitable for bifurcation treatment as its mechanical properties are closer to those of permanent metallic drug‐eluting stents. Methods The study was a proof‐of‐concept study with planned inclusion of 20 patients with stable angina pectoris and a bifurcation lesion involving a large side branch (SB) > 2.5 mm with less than 50% diameter stenosis. Procedure and healing response were evaluated by optical coherence tomography (OCT). The main endpoints were a composite clinical safety endpoint and an OCT healing index at 1 month (range: 0–98). Results Eleven patients were included in the study. The study was prematurely terminated due to scaffold fractures and embolization of scaffold fragments in three cases requiring bailout stenting with drug‐eluting stents. One patient underwent bypass surgery at 3 months due to stenosis proximal to the study segment. All SB were patent for 1 month. One‐month OCT evaluation showed strut coverage of 96.9% and no malapposition. Scaffold fractures and uncovered jailing struts resulted in a less favorable mean OCT healing index score of 10.4 ± 9.0. Conclusions Implanting a magnesium scaffold by the provisional technique in nontrue bifurcation lesions was associated with scaffold fracture, embolization of scaffold fragments, and a high need for bailout stenting.
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Affiliation(s)
- Trine Ø Barkholt
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Omeed Neghabat
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Emil N Holck
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Lene N Andreasen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Niels R Holm
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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Boeder NF, Dörr O, Koepp T, Blachutzik F, Achenbach S, Elsässer A, Hamm CW, Nef HM. Acute Mechanical Performance of Magmaris vs. DESolve Bioresorbable Scaffolds in a Real-World Scenario. Front Cardiovasc Med 2021; 8:696287. [PMID: 34195239 PMCID: PMC8236697 DOI: 10.3389/fcvm.2021.696287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 05/21/2021] [Indexed: 02/03/2023] Open
Abstract
Background: After the bioresorbable PLLA-based vascular scaffold (Absorb BVS) was taken from the market due to its high adverse event rates, a magnesium-based scaffold (Magmaris) was introduced. Objective: To compare the acute performance of the sirolimus-eluting magnesium alloy Magmaris scaffold with that of the novolimus-eluting PLLA-based DESolve scaffold in terms of appropriate scaffold deployment using optical coherence tomography (OCT). Methods and Results: Data from the final OCT pullback of 98 patients were included (19 Magmaris, 79 DESolve) and analyzed at 1-mm intervals. The following indices were calculated: mean and minimal area, residual area stenosis, incomplete strut apposition, tissue prolapse, eccentricity index, symmetry index, strut fracture, and edge dissection. OCT showed a minimum lumen area for Magmaris vs. DESolve of 6.6 ± 1.6 vs. 6.0 ± 1.9 (p = 0.06). Scaffolds with residual area stenosis >20% were predominantly seen in the DESolve group (15.8 vs. 46.8%; p = 0.01). The mean eccentricity index did differ significantly (0.74 ± 0.06 vs. 0.63 ± 0.09; p < 0.001). No fractures were observed for Magmaris scaffolds, but 15.2% were documented for DESolve BRS (p < 0.001). Incomplete scaffold apposition area was significantly higher in the DESolve group (0.01 ± 0.02 vs. 1.05 ± 2.32 mm2; p < 0.001). Conclusion: This is the first study to compare the acute mechanical performance between Magmaris and DESolve in a real-world setting. The acute mechanical performance of Magmaris BRS seems to be superior to that of DESolve BRS, whereas OCT showed a good acute mechanical performance for both BRS in terms of generally accepted imaging criteria.
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Affiliation(s)
- Niklas F Boeder
- Medical Clinic I, University Hospital of Giessen, Giessen, Germany
| | - Oliver Dörr
- Medical Clinic I, University Hospital of Giessen, Giessen, Germany
| | - Tim Koepp
- Medical Clinic I, University Hospital of Giessen, Giessen, Germany
| | | | - Stephan Achenbach
- Medical Clinic 2, University Hospital of Erlangen, Erlangen, Germany
| | - Albrecht Elsässer
- Department of Cardiology, University Hospital of Oldenburg, Oldeburg, Germany
| | - Christian W Hamm
- Medical Clinic I, University Hospital of Giessen, Giessen, Germany.,Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany.,German Centre for Cardiovascular Research, RheinMain Chapter, Frankfurt am Main, Germany
| | - Holger M Nef
- Medical Clinic I, University Hospital of Giessen, Giessen, Germany
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Cortes C, Chu M, Schincariol M, Martínez-Hervás Alonso M, Reisbeck B, Zhang R, Murasato Y, Chen SL, Lavarra F, Tu S, Silber S, Gutiérrez-Chico JL. Identification of the type of stent with three-dimensional optical coherence tomography: the SPQR study. EUROINTERVENTION 2021; 17:e140-e148. [PMID: 32928714 PMCID: PMC9724971 DOI: 10.4244/eij-d-20-00598] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The ability of optical coherence tomography (OCT) to identify specific types of stent has never been systematically studied. AIMS The aim of this study was to test the accuracy of OCT imaging to identify patterns of stent platform and subsequently identify the type of stent implanted. METHODS Consecutive patients from six international centres were retrospectively screened, searching for OCT studies with metallic stents or scaffolds. The sample was analysed by two blinded operators, applying a dedicated protocol in four steps to identify the type of stent: 1) 3D and automatic strut detection (ASD), 2) 3D tissue view, 3) longitudinal view with ASD, 4) mode "stent only" and ASD. RESULTS A series of 212 patients underwent OCT in the study centres, finding 294 metallic stents or scaffolds in 146 patients. The protocol correctly identified 285 stents (96.9%, kappa 0.965), with excellent interobserver agreement (kappa 0.988). The performance tended to be better in recently implanted stents (kappa 0.993) than in stents implanted ≥3 months before (kappa 0.915), and in pullback speed 18 mm/s as compared with 36 mm/s (kappa 0.969 vs 0.940, respectively). CONCLUSIONS The type of stent platform can be accurately identified in OCT by trained analysts following a dedicated protocol, combining 3D-OCT, ASD and longitudinal view. This might be clinically helpful in scenarios of device failure and for the quantification of apposition. The blinding of analysts in OCT studies should be revisited.
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Affiliation(s)
- Carlos Cortes
- Klinikum Frankfurt (Oder), Frankfurt, Germany,San Pedro Hospital, Logroño, Spain
| | - Miao Chu
- Cardiology Department, Campo de Gibraltar Health Trust, Algeciras, Spain,Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | | | | | - Bernd Reisbeck
- Cardiology Department, Campo de Gibraltar Health Trust, Algeciras, Spain
| | - Ruiyan Zhang
- Ruijin Hospital, Shanghai, China,Medical University, Shanghai Jiao Tong University, Shanghai, China
| | | | | | | | - Shengxian Tu
- Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
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Park S, Lee H, Kim HE, Jung HD, Jang TS. Bifunctional poly (l-lactic acid)/hydrophobic silica nanocomposite layer coated on magnesium stents for enhancing corrosion resistance and endothelial cell responses. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 127:112239. [PMID: 34225879 DOI: 10.1016/j.msec.2021.112239] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 05/25/2021] [Accepted: 06/02/2021] [Indexed: 11/28/2022]
Abstract
Biodegradable magnesium (Mg)-based vascular stents can overcome the limitations of conventional permanent metallic stents, such as late in-stent restenosis and thrombosis, but still have difficulty retarding degradation while providing adequate mechanical support to the blood vessel. We incorporated silica nanoparticles surface-functionalized with hexadecyltrimethoxysilane (mSiNP) into a poly (l-lactic acid) (PLLA) coating as a physical barrier to disturb the penetration of the corrosive medium as well as a bioactive source that releases silicon ions capable of stimulating endothelial cells. The corrosion resistance and biocompatibility of this bifunctional PLLA/mSiNP nanocomposite coating were investigated using different weight ratios of mSiNP. The nanocomposite coating containing more than 10 wt% of the mSiNP (PLLA/10mSiNP and PLLA/20mSiNP) significantly delayed the corrosion of the Mg substrate and exhibited favorable endothelial cell responses, compared to the pure PLLA coating. Specifically, the calculated corrosion rates of PLLA/10mSiNP and PLLA/20mSiNP decreased by half, indicating the durability of the coating after immersion in simulated body fluid for 12 days. Based on the in vitro cellular response, the incorporation of the mSiNPs into the PLLA coating significantly improved the endothelial cell responses to the Mg substrate, showing better initial cell surface coverage, migration, and proliferation rate than those of pure PLLA. These results indicate that the PLLA/mSiNP nanocomposite coatings have significant potential to improve the corrosion resistance and vascular compatibility of biodegradable Mg-based vascular stents.
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Affiliation(s)
- Suhyung Park
- Department of Materials Science and Engineering, Seoul National University, Seoul, Republic of Korea
| | - Hyun Lee
- Department of Biomedical-Chemical Engineering, Catholic University of Korea, Bucheon, Republic of Korea; Department of Biotechnology, The Catholic University of Korea, Bucheon 14662, Republic of Korea
| | - Hyoun-Ee Kim
- Department of Materials Science and Engineering, Seoul National University, Seoul, Republic of Korea; Biomedical Implant Convergence Research lab, Advanced Institutes of Convergence Technology, Suwon, Republic of Korea
| | - Hyun-Do Jung
- Department of Biomedical-Chemical Engineering, Catholic University of Korea, Bucheon, Republic of Korea; Department of Biotechnology, The Catholic University of Korea, Bucheon 14662, Republic of Korea.
| | - Tae-Sik Jang
- Department of Materials Science and Engineering, Chosun University, Gwangju, Republic of Korea.
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Wu X, Wu S, Kawashima H, Hara H, Ono M, Gao C, Wang R, Lunardi M, Sharif F, Wijns W, Serruys PW, Onuma Y. Current perspectives on bioresorbable scaffolds in coronary intervention and other fields. Expert Rev Med Devices 2021; 18:351-365. [PMID: 33739213 DOI: 10.1080/17434440.2021.1904894] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: The first-generation bioresorbable scaffolds (BRSs) had a large strut profile to compensate for the insufficient radial strength of bioresorbable polymer materials, resulting in higher scaffold thrombosis rates than conventional drug-eluting stents. To improve the clinical safety and efficacy, the new generation BRSs have been improved by optimal structure design, post-processing of bioresorbable polymer materials, or altering bioresorbable metallic alloys.Areas covered: This review summarizes the lessons learned from the first-generation BRS, updates the clinical outcomes of trials evaluating ABSORB bioresorbable vascular scaffold at long-term and bioresorbable metallic alloy-based devices, and examines recent outcomes of BRS treated in STEMI patients. This review also provides an overview of the current clinical data of seven BRSs manufactured in Asia, and of the BRSs extended application in other clinical arenas.Expert opinion: Drawbacks of the first-generation BRSs need to be addressed by the next generation of these stents with novel materials and technologies. Clinical research, including randomized controlled trials, are required to further evaluate BRSs application in coronary artery disease. The encouraging results of BRSs innovation applied in the peripheral arteries and gastrointestinal tracts support other potential clinical applications of BRS technology.
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Affiliation(s)
- Xinlei Wu
- Institute of Cardiovascular Development and Translational Medicine, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland
| | - Sijing Wu
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland.,Department of Cardiology, Beijing Anzhen Hospital, Beijing, China
| | - Hideyuki Kawashima
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland
| | - Hironori Hara
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland
| | - Masafumi Ono
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland
| | - Chao Gao
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland.,Department of Cardiology, Xijing Hospital, Xi'an, China
| | - Rutao Wang
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland.,Department of Cardiology, Xijing Hospital, Xi'an, China
| | - Mattia Lunardi
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland
| | - Faisal Sharif
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland
| | - William Wijns
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland.,National Heart & Lung Institute, Imperial College London, London, UK
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland
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Lin LH, Lee HP, Yeh ML. Characterization of a Sandwich PLGA-Gallic Acid-PLGA Coating on Mg Alloy ZK60 for Bioresorbable Coronary Artery Stents. MATERIALS (BASEL, SWITZERLAND) 2020; 13:E5538. [PMID: 33291735 PMCID: PMC7730464 DOI: 10.3390/ma13235538] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 02/07/2023]
Abstract
Absorbable magnesium stents have become alternatives for treating restenosis owing to their better mechanical properties than those of bioabsorbable polymer stents. However, without modification, magnesium alloys cannot provide the proper degradation rate required to match the vascular reform speed. Gallic acid is a phenolic acid with attractive biological functions, including anti-inflammation, promotion of endothelial cell proliferation, and inhibition of smooth muscle cell growth. Thus, in the present work, a small-molecule eluting coating is designed using a sandwich-like configuration with a gallic acid layer enclosed between poly (d,l-lactide-co-glycolide) layers. This coating was deposited on ZK60 substrate, a magnesium alloy that is used to fabricate bioresorbable coronary artery stents. Electrochemical analysis showed that the corrosion rate of the specimen was ~2000 times lower than that of the bare counterpart. The released gallic acid molecules from sandwich coating inhibit oxidation by capturing free radicals, selectively promote the proliferation of endothelial cells, and inhibit smooth muscle cell growth. In a cell migration assay, sandwich coating delayed wound closure in smooth muscle cells. The sandwich coating not only improved the corrosion resistance but also promoted endothelialization, and it thus has great potential for the development of functional vascular stents that prevent late-stent restenosis.
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Affiliation(s)
- Li-Han Lin
- Department of Biomedical Engineering, National Cheng Kung University, Tainan 701, Taiwan;
| | - Hung-Pang Lee
- Biomedical Engineering, Dwight Look College of Engineering, Texas A&M University, College Station, TX 77843, USA;
| | - Ming-Long Yeh
- Department of Biomedical Engineering, National Cheng Kung University, Tainan 701, Taiwan;
- Medical Device Innovation Center, National Cheng Kung University, Tainan 701, Taiwan
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Long-term comparison of everolimus- vs. novolimus-eluting bioresorbable vascular scaffolds in real world patients. Adv Cardiol 2020; 16:391-398. [PMID: 33598011 PMCID: PMC7863837 DOI: 10.5114/aic.2020.101763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 08/22/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Elevated risk of adverse events in comparison to metallic stents resulted in withdrawal of everolimus-eluting bioresorbable scaffolds (eBVS), known as the most intensively studied BVS. There is a paucity of data comparing the two different BVS. AIM To evaluate the long-term clinical outcomes of the novolimus-eluting bioresorbable vascular scaffold (nBVS) compared with eBVS. MATERIAL AND METHODS Consecutive patients treated with nBVS or eBVS in our center were screened. The primary outcome was the 3-year rate of major adverse cardiovascular events (MACE), defined as the composite of cardiac death, target vessel myocardial infarction (TV-MI), and target-lesion revascularization (TLR). RESULTS After matching, 98 patients treated with 135 eBVS were compared with 98 patients treated with 136 nBVS. Baseline characteristics, clinical presentation, and lesion characteristics were comparable in both groups. The 3-year MACE rate was higher in the eBVS group (17.3% vs. 6.1%; p log-rank = 0.02). The occurrence of TLR (16.3% vs. 5.1%; p log-rank = 0.02) and TV-MI (8.2% vs. 0 %; p log-rank = 0.004) was also higher in the eBVS group except for cardiac deaths (1% vs. 2%; p log-rank = 0.98, eBVS vs. nBVS, respectively). Of note, definite device thrombosis rate was markedly increased in the eBVS group (5.1% vs. 0%; p log-rank = 0.03). CONCLUSIONS The present study revealed that the 3-year event risk was lower for nBVS compared to eBVS. More evidence is needed to evaluate long-term performance of novolimus-eluting biovascular platforms.
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Bayon J, González‐Juanatey C. Resorbable magnesium scaffolds: The learning curve continues…Reply. Catheter Cardiovasc Interv 2020; 96:E559-E560. [DOI: 10.1002/ccd.28816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 02/14/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Jeremias Bayon
- Interventional Cardiology Unit Hospital Universitario Lucus Augusti Lugo Galicia Spain
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Haude M, Ince H, Kische S, Toelg R, Van Mieghem NM, Verheye S, von Birgelen C, Christiansen EH, Barbato E, Garcia-Garcia HM, Waksman R. Sustained Safety and Performance of the Second-Generation Sirolimus-Eluting Absorbable Metal Scaffold: Pooled Outcomes of the BIOSOLVE-II and -III Trials at 3 Years. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1150-1154. [PMID: 32917533 DOI: 10.1016/j.carrev.2020.04.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/03/2020] [Accepted: 04/03/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND/PURPOSE To avoid long-term effects associated with permanent implants, bioresorbable vascular scaffolds were developed, as they provide transient vessel support and disappear thereafter. The aim of the BIOSOLVE-II and -III studies was to assess the safety and performance of a magnesium-based sirolimus-eluting scaffold; we report the clinical outcomes at 3 years, 2 years after scaffold resorption. METHODS/MATERIALS BIOSOLVE-II and BIOSOLVE-III are international, prospective multi-center studies, including 184 patients with 189 de novo lesions and stable or unstable angina, or documented silent ischemia. Acute myocardial infarction, 3-vessel coronary artery disease, and heavily calcified lesions were excluded. Antiplatelet therapy was recommended for 6 months. RESULTS Patients were 65.5 ± 10.8 years old, and lesions were 12.1 ± 4.5 mm long and located in vessels with a diameter of 2.7 ± 0.4 mm. More than half of the lesions (56.5%) were type B2/C lesions. At 2 years, 92.5% (160/173) of patients were symptom-free and 91.5% (151/165) at 3 years; all the other patients had stable angina. At 3 years, target lesion failure occurred in 11 patients (6.3%), consisting of 4 cardiac deaths (2.3%), one target-vessel myocardial infarction (0.6%), and 6 clinically driven target lesion revascularizations (3.4%). There was no definite or probable scaffold thrombosis. CONCLUSION In a low-risk patient population, treatment with a sirolimus-eluting magnesium bioresorbable scaffold can be considered safe, in particular with no definite or probable scaffold thrombosis. ANNOTATED TABLE OF CONTENTS BIOSOLVE-II and -III are prospective, international, multi-center studies including 184 patients with de novo lesions. At 3 years, target lesion failure was 6.3%, consisting of 4 cardiac deaths (2.3%), one target-vessel myocardial infarction (0.6%), and 6 clinically driven target lesion revascularizations (3.4%). There was no definite or probable scaffold thrombosis.
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Affiliation(s)
- Michael Haude
- Medical Clinic I, Städtische Kliniken Neuss, Lukaskrankenhaus GmbH, Neuss, Germany.
| | - Hüseyin Ince
- Department of Cardiology, Vivantes Klinikum im Friedrichshain and Am Urban, Berlin, Germany; Department of Cardiology, Universitätsmedizin Rostock, Germany
| | - Stephan Kische
- Department of Cardiology, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Ralph Toelg
- Herzzentrum Segeberger Kliniken GmbH, Bad Segeberg, Germany
| | | | - Stefan Verheye
- Interventional Cardiology Middelheim Hospital, Antwerpen, Belgium
| | - Clemens von Birgelen
- Department of Cardiology, Medisch Spectrum Twente, Thoraxcentrum Twente, Enschede, the Netherlands
| | | | - Emanuele Barbato
- Cardiovascular Research Center Aalst, OLV Hospital, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | | | - Ron Waksman
- Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
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Barkholt TØ, Webber B, Holm NR, Ormiston JA. Mechanical properties of the drug-eluting bioresorbable magnesium scaffold compared with polymeric scaffolds and a permanent metallic drug-eluting stent. Catheter Cardiovasc Interv 2019; 96:E674-E682. [PMID: 31710149 PMCID: PMC7754471 DOI: 10.1002/ccd.28545] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 10/05/2019] [Indexed: 11/24/2022]
Abstract
Objectives To compare on the bench the physical and mechanical properties of Magmaris, a magnesium bioresorbable scaffold (BRS), with Absorb and DESolve polymeric BRS and a permanent metallic stent. Background Understanding the mechanical and physical properties of BRS is crucial for appropriate implantation and postdilatation. Methods Testing was performed in fluid at 37°C and in silicone bifurcation phantoms with a 30° angle between main branch (MB) and side branch. Results The 3.0‐mm Magmaris BRS did not fracture after MB postdilatation up to 4.4 mm in contrast to the Absorb where the safe postdilatation diameter was 3.7 mm. For dilatation through stent cells, there were no Magmaris fractures with 3.0‐mm noncompliant (NC) balloons inflated to nominal pressure. Mini‐kissing balloon postdilatation with two 3.0‐mm NC balloons up to 17 atm was without fracture except for an outlier. Longitudinal and radial strengths were similar for Magmaris and Absorb BRS. The crossing profile for the Magmaris was larger than other devices. Recoil 120 min after deployment was the greatest for Magmaris but 120 min after 3.5 mm postdilatation all devices had similar diameters. Conclusions The Magmaris BRS was more resistant to strut fracture than Absorb. It had a larger crossing profile than other devices and similar radial and longitudinal strengths to Absorb. While recoil after deployment was greater with Magmaris, 120 min after 3.5 mm postdilatation all devices had similar diameters.
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Affiliation(s)
| | | | | | - John A Ormiston
- Intra, Auckland, New Zealand.,University of Auckland, Auckland, New Zealand
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